Sub-study I examined the associations between various sociodemographic, health and migration related factors and mobility limitation. Age was found to increase the odds for mobility limitation in the foreign-born populations and in the general population in Finland (odds ratio [OR] 1.09; 95% confidence interval [CI] 1.07–1.10). Also being unemployed (OR 1.83; 95% CI 1.26–2.66) or economically inactive (OR 2.14; 95% CI 1.53–2.98) increased the odds for mobility limitation in all the groups. There were, instead, differences in the associations between education, economic situation and mobility limitation between the groups. A low level of education increased the odds for mobility limitation in all other groups except for the population of Russian origin, while a difficult economic situation increased the odds for mobility limitation only in the general population (OR 4.66; 95% CI 2.58–8.42). Obesity (OR 2.74; 95% CI 2.05–3.67), chronic conditions (OR 2.37; 95% CI 1.79–3.15), and injuries (OR 2.67; 95% CI 1.78–4.00) clearly increased the odds for mobility limitation. Time in Finland or language proficiency in Finnish and Swedish did not show an association with mobility limitation.
Sub-study II examined the associations between various sociodemographic factors and mental health symptoms. Age increased the odds for mental health symptoms in Russian (OR 3.03; 95% CI 1.63–5.65) and Kurdish origin women (OR 1.76; 95% CI 1.08–2.86). In Russian origin men and men in the general population, those who were not married or cohabiting had increased odds for mental health symptoms (OR 8.65; 95% CI 1.44–51.87 and OR 5.54; 95% CI 2.29–13.42, respectively). A low level of education increased the odds for mental health symptoms only in Kurdish origin men (OR 2.11; 95% CI 1.17–3.83). A difficult financial situation increased the odds for mental health symptoms in women in all the studied groups (Russian origin OR 4.44, 95% CI 2.27–8.68; Somali origin OR 4.65, 95% CI 1.02–21.15; Kurdish origin OR 2.39, 95% CI 1.39–4.09) and Kurdish origin men (OR 2.87; 95% CI 1.46–5.63). Unemployment and economic inactivity increased the odds for mental health symptoms in Kurdish origin women (OR 1.94; 95% CI 1.05–3.57). In the general population, unemployment was associated with mental health symptoms in both men (OR 20.26; 95% CI 6.71–61.20) and women (OR 36.61; 95% CI 7.15–187.41), and economic inactivity in women (OR 6.67; 95% CI 2.62– 16.97).
No association was found between migration-related factors and mental health symptoms in men. In women, living in Finland for less than six years increased the odds for mental health symptoms in persons of Somali (OR 4.33; 95% CI 1.23–15.21) and Kurdish origin (OR 2.21; 95% CI 1.06–4.64). Poor knowledge of Finnish and Swedish increased the odds for mental health symptoms among persons of Russian (OR 3.46; 95% CI 1.50–7.98) and Kurdish origin (OR 2.15; 95% CI 1.09–4.21). Moving to Finland at the age of 18 years or older increased the odds for mental health symptoms in Kurdish origin women (OR 2.16; 95% CI 1.11–4.20), while a refugee background decreased this odds
ratio (OR 0.47; 95% CI 0.27–0.82). No significant associations were found between illiteracy and mental health symptoms.
The associations between mental health symptoms and mobility limitation were examined in sub-study III (Table 7). In Kurdish origin men, anxiety symptoms, but not depressive symptoms, were associated with mobility limitation, while in men in the general population, depressive symptoms, but not anxiety symptoms, were associated with mobility limitation. Depressive symptoms increased the odds for mobility limitation in women in all of the studied groups. Anxiety symptoms increased the odds for mobility limitation in Russian and Kurdish origin women and women in the general population. This association was also near statistical significance in Somali origin women.
Table 7. Association between mental health symptoms and mobility limitation1
Russian origin Somali origin Kurdish origin Ref. group
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
MEN Depression2 NA NA 1.85 (0.87–3.94) 4.58 (1.55–13.53) Anxiety3 NA NA 2.74 (1.15–6.54) 3.32 (0.84–13.12) WOMEN Depression2 2.78 (1.18–6.54) 4.90 (1.08–22.22) 2.74 (1.49–5.05) 4.34 (1.87–10.08) Anxiety3 2.64 (1.16–6.01) 6.98 (0.99–49.09) 3.20 (1.74–5.90) 8.08 (3.05–21.43) 1
Logistic regression modelling the probability of having depressive symptoms / anxiety symptoms, adjusted for age and education
2
Depressive symptoms, Hopkins Symptom Checklist-25, depression subscale, cut-off point > 1.75 3
Anxiety symptoms, Hopkins Symptom Checklist-25, anxiety subscale, cut-off point > 1.75
OR=odds ratio, bolded ORs are statistically significant associations; 95% CI=95% confidence interval NA=not applicable, Russian and Somali origin men were excluded due to too few observations Ref. group=comparison group from the general population in Finland
6.5 Perceived discrimination and its association with health (IV)
The prevalences of reporting no discrimination, subtle discrimination only and overt or subtle and overt discrimination were examined in sub-study IV (Table 8). No experiences of discrimination were reported by 59% of Russian origin persons, 62% of Kurdish origin persons and 63% of Somali origin persons. Experiences of subtle discrimination were more common than overt discrimination in all three groups. Subtle discrimination, meaning treated less politely than others and/or treated less respectfully than others, was reported by 29% of Somali origin persons and 35% of persons of Russian or Kurdish origin. Overt discrimination, meaning called names or insulted and/or threatened or harassed, was reported by 22% of Russian origin persons, 23% of Kurdish origin persons and 24% of Somali origin persons. Among persons of Russian origin, 19% reported only subtle experiences of discrimination, and 22% reported either overt or both overt and subtle experiences. These figures among Somali origin persons were 12% and 24%, and among Kurdish origin persons 16% and 23%.The prevalence of perceived discrimination was also examined by reason for migration and region in Finland. No differences in the prevalence of discrimination were found by reason for migration. Experiences of discrimination were, instead, shown to differ by region in Finland. Among persons of Russian origin, experiences of discrimination were less common in the capital city, while experiencing overt or subtle and overt discrimination was more common among those living in the other cities. Among persons of Somali origin, the prevalence of perceived discrimination varied significantly by region: 41% of the Somali origin participants living in the capital city area reported any experiences of perceived discrimination, while only 13% of the participants living in the other cities (Turku and Tampere) reported experiences of discrimination. Among persons of Kurdish origin, no differences in the prevalence of perceived discrimination by region were found.
Experiencing subtle discrimination only increased the odds for poor self-rated health (SRH) among persons of Russian and Kurdish origin (Table 9). These associations remained statistically significant also in Model 2, which adjusted for education, time since migration and region of residence in Finland, in addition to age and gender. Among Somali origin persons, significant associations between discrimination and SRH were found only in the gender-stratified analyses for women reporting overt or subtle and overt discrimination. Experiencing subtle discrimination only increased the odds for limiting long-term illness or disability (LLTI) among persons of Russian and Kurdish origin, both in Models 1 and 2. Among persons of Somali origin, the associations between discrimination and LLTI were not statistically significant. Perceived discrimination increased the odds for mental health symptoms, and these associations were found both for those reporting subtle discrimination only and for those reporting overt or subtle and overt discrimination, in Models 1 and 2 alike. The associations between perceived discrimination and mental health could, however, be examined only among persons of
Russian and Kurdish origin, since too few observations of mental health symptoms were found for persons of Somali origin.
Table 8. The prevalence of perceived discrimination in the studied groups1
No discrimination Subtle 2
discrimination only Overt
3 or subtle and
overt discrimination p-value4
Russian origin 58.9 19.0 22.1 Capital city 60.6* 20.2 19.2** 0.016 Other cities5 53.9 17.0 29.1 Somali origin 63.4 12.3 24.3 Capital city 59.5*** 13.5** 27.0*** <0.001 Other cities5 87.1 3.3 9.6 Kurdish origin 61.7 15.5 22.8 Capital city 62.6 15.6 21.9 0.515 Other cities5 60.0 14.4 25.5 p-value6 0.522 0.013 0.801
1Weighted prevalence adjusted for age and gender
2Reporting being treated less politely than others and/or treated less respectfully than others 3Reporting being called names or insulted and/or threatened or harassed
4Difference within each group by region in Finland; *p-value < 0.05; **p-value < 0.01; ***p-value < 0.001 5Turku, Tampere and Vaasa for Russian and Kurdish origin group, Turku and Tampere for Somali origin 6Difference between the three groups in the overall prevalence of different types of discrimination (Satterthwaite adjusted F-statistic), bolded p-values are statistically significant (<0.05)
Table 9. Association between discrimination and health1 Russian origin (n=684) OR (95% CI) Somali origin (n=475) OR (95% CI) Kurdish origin (n=610) OR (95% CI) MODEL 1 Self-rated health No discrimination 1.00 1.00 1.00
Subtle discrimination only2 2.34 (1.47–3.74) 1.65 (0.62–4.37) 1.65 (1.00–2.72) Overt3 or subtle and overt 1.35 (0.81–2.24) 1.77 (0.83–3.77) 1.19 (0.78–1.80) Limiting long-term illness
No discrimination 1.00 1.00 1.00
Subtle discrimination only2 1.77 (1.12–2.80) 1.20 (0.48–2.99) 2.21 (1.38–3.55) Overt3 or subtle and overt 1.40 (0.87–2.24) 1.11 (0.55–2.26) 0.94 (0.60–1.46) Mental health symptoms
No discrimination 1.00 NA 1.00
Subtle discrimination only2 2.37 (1.23–4.57) 1.74 (1.06–2.86)
Overt3 or subtle and overt 2.59 (1.35–4.97) 1.67 (1.07–2.63)
MODEL 2 Self-rated health
No discrimination 1.00 1.00 1.00
Subtle discrimination only2 2.30 (1.42–3.73) 1.67 (0.58–4.77) 1.78 (1.04–3.05)
Overt3 or subtle and overt 1.50 (0.87–2.59) 2.12 (0.91–4.94) 1.39 (0.91–2.14) Limiting long-term illness
No discrimination 1.00 1.00 1.00
Subtle discrimination only2 1.71 (1.07–2.74) 1.13 (0.44–2.91) 2.43 (1.50–3.95) Overt3 or subtle and overt 1.52 (0.92–2.51) 1.03 (0.48–2.19) 0.99 (0.63–1.56) Mental health symptoms
No discrimination 1.00 NA 1.00
Subtle discrimination only2 2.40 (1.24–4.64) 1.95 (1.17–3.25)
Overt3 or subtle and overt 2.45 (1.22–4.90) 2.02 (1.28–3.21)
1
Logistic regression, modeling the probability of having poor self-rated health/limiting long-term illness or disability/mental health symptoms
2
Reporting being treated less politely than others and/or treated less respectfully than others 3
Reporting being called names or insulted and/or threatened or harassed
OR=odds ratio, bolded ORs are statistically significant associations; 95% CI=95% confidence interval Model 1 adjusting for age and gender